o o Thank you for choosing Clover Park Technical College! We look forward to welcoming you to CPTC soon!

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1 Thank yu fr requesting the CPTC Internatinal Admissin Applicatin Packet! T cmplete yur admissin, please fill ut the fllwing frms and submit with the dcuments belw: FORMS Internatinal Educatin Admissins Frm Internatinal Financial Respnsibility Verificatin Frm Internatinal Student Health Insurance Agreement Credit Card Authrizatin Frm (nly if yu wish t pay yur applicatin fee by credit card) DOCUMENTS Original bank statement r fficial letter frm yur bank manager w/ signature n the bank s letterhead The bank statement/letter shuld be: N lder than 6 mnths Shws funds sufficient fr the first year f yur study The cst fr tuitin, fees, health insurance, instructinal materials (textbks, clthing, tls, etc.), hmestay and persnal expenses fr 4 quarters (12 mnths) varies depending n yur prgram f study. Please cntact us fr a ttal amunt needed fr yur bank statement. If yu have dependent(s) cming t US with yu, add $2,250 per each dependent family member Phtcpy/scanned cpy f financial dcuments, n-line r ATM printut f accunt balance will NOT be accepted Affidavit f Supprt (if yu have a spnsr living in the US) Applicatin Fee - $50.00 (ne-time nly, nn-refundable) The applicatin fee is payable by persnal check, mney rder, r credit card with authrized signature. Fr credit card payment, please use the attached Credit Card Authrizatin Frm. Cpy f yur passprt Prf f English Prficiency (TOEFL r IELTS, etc. Please cntact us fr the scres required fr admissin) A passprt size pht A shrt essay abut yu and yur educatin & career gals HOUSING If yu wish t live with American hst family, please let us knw. Pierce Cllege s Husing Office helps us with hmestay placement. We will send yu Peirce Cllege s Hmestay Placement Applicatin Frm. The placement fee is $250 (nnrefundable). If yu are TRANSFERING TO CPTC: In additin t the frms and dcuments listed abve, please als submit the fllwings: Internatinal Student Transfer Eligibility Verificatin Frm (T be cmpleted and signed by yu and the internatinal advisr f yur current schl) Cpy f all yur I-20s Cpy f yur passprt, visa, and I-94 Official transcripts frm yur previus and current schls in U.S. If yu have any questins, please feel free t cntact us at Internatinal Educatin Prgrams by calling r via at Thank yu fr chsing Clver Park Technical Cllege! We lk frward t welcming yu t CPTC sn!

2 INTERNATIONAL EDUCATION ADMISSIONS FORM Internatinal Educatin Prgrams 4500 Steilacm Blvd. S.W. Please tell us hw yu learned abut Clver Park Technical Cllege: Lakewd, WA USA A friend r agent Advertisement Internet Tel: Fax: Educatin Fair CPTC Student, Instructr r Staff Other TYPE OR PRINT USING BLOCK LETTERS FAMILY NAME AS PRINTED ON PASSPORT FIRST NAME MIDDLE PREVIOUS LAST NAME FEMALE MALE MOTHER S NAME FATHER S NAME DATE OF BIRTH MM/DD/YYYY COUNTRY OF BIRTH: CITIZENSHIP: NATIVE LANGUAGE: WHAT QUARTER DO YOU PLAN TO BEGIN? SUMMER / JUNE-July FALL / SEPTEMBER WINTER / JANUARY SPRING / MARCH-APRIL PROGRAM YOU WISH TO ENTER AT CPTC: 2 ND OPTION DO YOU PLAN TO TRANSFER TO A FOUR-YEAR COLLEGE OR UNIVERSITY AFTER ATTENDING CPTC? YES NO IF CURRENTLY IN THE U.S., WHAT IS YOUR VISA CLASSIFICATION: F-1 M-1 OTHER VISA # PASSPORT WITH I-94 REQUIRED EXPIRATION DATE: EDUCATION: NAME OF HIGH SCHOOL: COUNTRY: DATES ATTENDED; GRADUATED? YES NO EDUCATION: MOST RECENT COLLEGE/UNIVERSITY: COUNTRY: DATES ATTENDED: GRADUATED? YES NO PERMANENT ADDRESS IN HOME COUNTRY STREET PROVINCE / /CITY / /COUNTY PERMANENT COUNTRY PERMANENT PHONE: YOUR ADDRESS IN U.S. STREET APT# CITY STATE ZIP CODE YOUR PHONE: EMERGENCY CONTACTS: NAME: PHONE: RELATIONSHIP: IMPORTANT INFORMATION; 1. All students are required t pay all tuitin and fees befre the start f class. Financial aid is nt available fr internatinal students. 2. Internatinal students must be cvered by health and accident insurance. Verificatin f insurance is required. Clver Park Technical Cllege is nt liable fr failure t cmply with this requirement. 3. Internatinal students must prvide the Internatinal Educatin Office with a current address and telephne number. 4. Internatinal students must maintain satisfactry prgress at all times r face pssible prbatin r withdrawal frm the cllege. 5. Internatinal students must maintain current VISA status and cmply with all regulatins regarding their VISA status r face pssible withdrawal frm the cllege. I UNDERSTAND THE ABOVE REQUIREMENTS AND DECLARE THAT THE INFORMATION I HAVE PROVIDED ON THIS FORM IS TRUE AND CORRECT, TO THE BEST OF MY KNOWLEDGE. NAME PRINT IN BLOCK LETTERS SIGNATURE DAT

3 Internatinal Educatin Prgrams 4500 Steilacm Blvd. S.W. Lakewd, WA USA Tel: Fax: INTERNATIONAL EDUCATION FINANCIAL RESPONSIBILITY VERIFICATION FORM All internatinal students are required by U.S. Department f Hmeland Security (DHS) t prve they have adequate funds t pay fr educatinal and living expenses during their stay in the U.S. In additin t cmpleting the infrmatin requested in this frm, prvide an riginal fficial bank statement shwing funds are available in U.S. dllars. TYPE OR PRINT USING BLOCK LETTERS FAMILY NAME AS PRINTED ON PASSPORT FIRST NAME MIDDLE PREVIOUS LAST NAME FEMALE MALE COUNTRY OF BIRTH: CITIZENSHIP: DATE OF BIRTH MM/DD/YYYY NATIVE LANGUAGE: PERMANENT ADDRESS IN HOME COUNTRY: street PROVINCE / CITY / COUNTY PERMANENT COUNTRY PERMANENT PHONE: YOUR ADDRESS IN U.S. STREET APT# CITY STATE ZIP CODE YOUR YOUR PHONE: EMERGENCY CONTACTS: NAME: PHONE: RELATIONSHIP: ASSURED SUPPORT FIRST YEAR: SOURCE OF FUNDS Self-Supprt: Attach a ntarized statement frm a bank fficial n the bank statinery verifying the amunt yu indicate. Parent r Individual Spnsr: Attach a statement frm the guarantr s bank verifying his/her ability t prvide yu with the funds yu indicate. The guarantr must als sign the certificatin prtin belw. Gvernment r Other Spnsring Agency: Enclse with this frm a signed cpy f yur letter f award, specifying the current date, dllar amunt, and the exact starting date and length f grant. Other: Specify. Enclse with this frm a signed affidavit frm an authrized persn t certify the accuracy f this entry. ASSURED SUPPORT SECOND YEAR: SOURCE OF FUNDS Self-Supprt: Attach a ntarized statement frm a bank fficial n the bank statinery verifying the amunt yu indicate. Parent r Individual Spnsr: Attach a statement frm the guarantr s bank verifying his/her ability t prvide yu with the funds yu indicate. The guarantr must als sign the certificatin prtin belw. Gvernment r Other Spnsring Agency: Enclse with this frm a signed cpy f yur letter f award, specifying the current date, dllar amunt, and the exact starting date and length f grant. Other: Specify. Enclse with this frm a signed affidavit frm an authrized persn t certify the accuracy f this entry. CERTIFICATION OF SOURCE OF FUNDS AND AMOUNTS. This is t certify that I have read the infrmatin furnished n this frm, that it is a true and accurate statement, and that the funds are available in U.S. currency and will be prvided as required. I UNDERSTAND THE ABOVE VERIFICATION AND DECLARE THAT THE INFORMATION I HAVE PROVIDED ON THIS FORM IS TRUE AND CORRECT, TO THE BEST OF MY KNOWLEDGE. NAME PRINT IN BLOCK LETTERS SIGNATURE DATE RELATIONSHIP TO STUDENT: PARENT RELATIVE OTHER, SPECIFY: GUARANTOR S PERMANENT ADDRESS: TELEPHONE:

4 Internatinal Student Health Insurance Agreement ALL internatinal students studying in the United States are required t carry a valid health insurance that cvers medical expenses in the U.S. Because medical cst in the U.S. is very expensive, it is imprtant that yu carry a health insurance in case f unexpected illness and injuries. As F-1/M-1 internatinal student, yu must carry a valid health insurance while maintaining a visa status. This includes while yu are enrlled in classes, during a vacatin quarter, AND during OPT (Optinal Practical Training). Clver Park Technical Cllege ffers the health insurance thrugh Firebird Internatinal Insurance Grup, LLC. The insurance premium fr is $ per quarter (three mnths), which is charged autmatically upn registratin. Nte: The OPT students are n lnger eligible fr the Cllege insurance. There is ther insurance ptin, s please cntact the Internatinal Prgrams Office staff fr mre infrmatin. Nt all medical treatments/prescriptin drugs are cvered by this insurance. Please read the Blanket Student Accident & Sickness Plan (the insurance bklet) carefully and familiarize yurself with what treatments are cvered and what cnditins are excluded under the insurance. Please d nt hesitate t ask if yu have any questins. If yu have yur wn health insurance frm yur cuntry, the quarterly insurance fee will be waived, but the insurance MUST have an equal r better cverage than the insurance ffered by the Cllege. Please submit a cpy f yur insurance card/dcument t Internatinal Prgrams Office fr evaluatin and as a prf f insurance cverage. Please check the bx, sign and date belw: I need the health insurance frm CPTC I have my wn insurance that is equal t r better than the Cllege insurance. I will submit a prf f my insurance. I, (print name), understand that all internatinal students must carry a valid health insurance while studying in the United States. I agree t pay the insurance fee each quarter, r keep my wn insurance valid, while I am enrlled, while I m n a vacatin quarter r while I m n OPT. I als understand that I m required t get the Cllege insurance if my wn insurance cverage is nt equal t r better than the Cllege insurance. When my wn insurance expires, I will renew it in a timely manner and submit a cpy f the new insurance card/dcument t Internatinal Prgrams Office. Signature Date

5 Internatinal Educatin Prgrams 4500 Steilacm Blvd. SW Lakewd, WA USA Tel: Fax: CREDIT CARD AUTHORIZATION FORM Student Name: Student ID#: Name f Card Hlder: Billing Address fr this card: Card Type (circle ne): Visa MasterCard (*AMEX and Discvery Card are NOT accepted) Card Number: Expiratin Date: / Security Cde: (The security cde is the last 3 digit numbers n the back f yur card) Amunt t be charged in US dllars: Applicatin Fee (M7): $50 Husing Fee (M8): $150 Health Insurance Fee (M9): $ Tuitin & Fees: $ (This fee is NOT the ABODE Hmestay applicatin fee) Other (please specify): $ fr Ttal: $ Signature f Card Hlder Date Imprtant Nte: An riginal cpy f this frm is needed t prcess charges. Please print this frm and send with yur applicatin by mail t: Internatinal Educatin Prgrams Clver Park Technical Cllege 4500 Steilacm Blvd. SW Lakewd, WA U.S.A. Updated 09/23/2013 yc

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